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About Jordan Wardrope

Jordan is a 4th Year Medical Student at the University of Dundee. He is undertaking a Longitudinal Clerkship in NHS Highland, based between Dingwall Medical Practice and Raigmore Hospital.
This new approach to undergraduate learning features a year-long placement with a GP practice, during which exposures to specialty input occur in the context of continuity of care and the patient's journey.

Author Archive | Jordan Wardrope

It’s been a while since the last update and our time on the Longitudinal Clerkship is moving on apace. Here are some views on the difference between an LC and the more conventional medical curriculum.

“tailor the week to the student’s needs”…

Seeing up to 20 patients myself in three days of GP is busy…it opens up lots of learning opportunities, identifies holes in your knowledge and creates space for reflection. However, this comes at the expense of other things – like assessments! The beauty of the LC though, is the flexibility to adapt the programme and tailor the week to the student’s needs. For example, through discussion with my tutor and practice manager, I now have a single slot every week that is fenced off for Mini-CEXs, Case Based Discussion and general PPD topics. We’ll both see the same number of patients in the day, but things have been tweaked a little to run more efficiently – this is a small change that makes a big difference – which can only be afforded by the flexibility of this new curriculum model.

…Secondary Care

Previously, I spent most of my time bouncing between outpatient clinics and ward rounds whilst in Raigmore. This was good for honing practical skills and experiencing various aspects of specialist care. However, more recently I have set up a number of mini-placements in various departments of the hospital. As a student with an enthusiasm towards acute care specialties, I was able to spend a full day in ICU – attending to some really ill patients and putting my long-forgotten physiology/biochemistry knowledge to the test. The great advantage of the LC is being able to arrange your own clinical attachments be it for personal/career interest or to fill in learning gaps. I hope to soon visit Paediatrics, Psychiatry, O&G and A&E as part of my involvement in secondary care.

Skillset…

Something I hadn’t appreciated before embarking on the LC were some of the skills and qualities we would develop throughout the year. The Scottish CMOs report, ‘Realistic Medicine’ really pedals the importance of communication, conversation and organisation. I really like the quote in the report:

“The single biggest problem with communication is the illusion that it has taken place.” George Bernard Shaw.

Relative to the conventional Dundee programme, I will see upwards of 500 patients in GP myself – handing over each and every case to my GP tutors throughout my time here. Furthermore, I write about 2-3 referrals per week to secondary care. No matter which career path I end up taking, the skills I will acquire from these forms of communication will prove hugely advantageous as all doctors are involved in handover and multidisciplinary care. I would have some exposure to these skills within the traditional programme but the constrained nature of 10x four-week blocks means that I wouldn’t get to see the result of the referral or the long-term impact on the patient and clinical team.

Q&A…

Q: Do you feel your colleagues have a better knowledge grasp because they focus on the same block for weeks at a time?

A: Yes, they probably do. You would expect a student who is studying cardiology for a week to be in the mind frame of cardiology – we can’t be that focussed because General Practice is General! However, I think their expertise is transient by the time finals come around and preparing for 5th Year and FY. We see a little of every speciality throughout the entire year, slowly topping up our memory banks rather than being intensely involved in one speciality for a month before forgetting it all in time for finals.

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Q: What elements of the curriculum are you missing out on?

A: This is a hard one. The quick answer is, I dont think there are any big areas we don’t experience. Most of medicine can be seen through the community, (I see my fair share of paediatrics, psychiatry and medicine in GP). Our secondary care time allows us to catch up on the things you naturally won’t see in GP (surgery & acute care for example). Of course there will be some super-specialist things we don’t see in the Highlands as the service isn’t provided here. However, what I think is just as important and to answer a question with a question – what do we experience on the LC that your typical medical student won’t?

3 months into our Longitudinal Clerkships and just before our Christmas break… now seems like an appropriate time to discuss the various opportunities afforded to students through the LC, both in academia and the community…

Opportunities in rural practice…

Under a fairly flexible schedule – I currently spend three half days Mon-Wed in General Practice undertaking my own consultations and seeing patients for review. This opens up the rest of these days to experience many other aspects of rural healthcare. Thus far I have been attached to a variety of healthcare providers including ambulance control, district nursing & the local pharmacy. Being one of very few students in the Highlands for a year opens up a number of doors. Last month I attended an Obstetrics Emergency Training session in Invergordon. This was run by midwives and provided some really valuable knowledge and practical experience in dealing with antenatal emergencies from the maternal and newborn perspectives. Collaborating with various members of the medical/nursing/midwifery MDT makes for a very broad experience and understanding of the rural healthcare system. I hope to further these truly enjoyable and unique insights into next year as well.

…Community Engagement

Helping out at the Ross County match

As part of our time in rural practice, we are encouraged to get as involved as possible with our surrounding communities. The idea behind this, is to encourage seeing our patients as people and not just individuals with a diagnosis. Most of our involvement revolves around youth and sports organisations such as the Scouts or Air Cadets. However, some students are assisting with the likes of the WRVS, Citizens Advice and even with the rehabilitation and well-being of offenders and ex-offenders.

Consolidation & Assessment…

Half of my week – Raigmore Hospital

This week, all of the DLIC Students (Highlands and Dumfries & Galloway) are back in Tayside for one of three ‘Dundee Weeks’ throughout the year. These provide an opportunity for formative assessments – both theoretical and practical OSCEs. This allows us benchmark our performance and identify areas for development, both in knowledge and in practice. These weeks also provide teaching on specialist aspects of medicine we may not cover in more remote settings and focus on particular specialties and presentations we are less familiar with. This week’s focus is on acute presentations in the elderly, medically unexplained symptoms as well as significant event analyses and difficult cases.

Winter in the Highlands…

It’s that time of year again – There’s snow on the Ben (Wyvis), Halloween is a distant memory, and the John Lewis Christmas add has started showing on the tele…or in ‘GP-land’, coughs and colds are doing their rounds and the flu-jab programme is well under way.

Here in the Highlands, we begin the daily windscreen defrosting routine going into week 9 of 40 on the Dundee Longitudinal Integrated Clerkship.

…”General Practice, it’s not always that simple!”

Since the last update, I have had a vast array of opportunities both in General Practice and in Secondary Care. Currently, I spend 3 days per week in GP, undertaking parallel consultations – this is where I see the patient for 10-20 minutes on my own, before handing over the case to my tutor and having a three-way discussion about the history, examination findings, impression and management plan. This is an ideal system, that gives me confidence in dealing with a range of patient presentations – however, in General Practice, it’s not always that simple!

Some more complex cases can take up to an hour all in, and I often find myself finishing that day with a number of learning points to research in my own time, and more often than not – a patient experience to reflect upon. On an average day, I tend to see between 4-6 patients in this format including routine appointments and on-the-day emergency bookings. This format lets me assess and manage acute cases as well as seeing patients for follow-up, acting on blood results or adapting on-going management strategies for example.

8 weeks have passed since I started on the L.C – this is the equivalent to 2 blocks within the traditional Dundee 4th Year programme. Accordingly, I have had the chance to really integrate with the medical team here in NHS Highlands. From liaising with nurses and HCAs to arrange basic testing for patients within the practice, collaborating with the secretaries for making referrals to Secondary care, to experiencing the processes behind Ambulance control – the other side of the phone call when I book a patient transfer or indeed when a 999 call goes out.

On the other two days of my working week, I go searching for activities within Raigmore Hospital. Often this will involve attending Outpatient Clinics – advancing my knowledge in areas I feel particularly weak in or those which I may have a particular interest in. Turning up to regular surgical and medical admissions ward rounds allows me to see a range of presentations and explore the dynamics of different teams and environments. Spending time on the wards allows me to keep my practical skills up-to-date, an important part of medical practice and, indeed, my Preparation in Practice assessment. Through attending ward rounds, I have had the opportunity to assist in theatre, acting as cameraman for various laparoscopic (key-hole) procedures. Having the flexibility to choose where and when I spend my time in hospital is great, as I can tailor clinical experiences to my own learning needs and interests. I hope to make arrangements in the near future to spend short blocks of 2-3 days at a time in the one specialty, particularly in Acute Care/Anaesthesia, Psychiatry, Paediatrics & Obstetrics – departments which require a bit more continuity to gain valuable clinical experience.

In the next update…I will be discussing the various opportunities a rural longitudinal clerkship offers and the highlights of community integration.

In September, seven medical students from the University of Dundee embarked on a totally new adventure – immersing themselves in either the Highlands or Dumfriesshire for their entire 4th Year.

Studying between Dingwall GP and Raigmore Hospital, I hope to provide regular updates throughout our 10-month journey on Scotland’s first ‘Longitudinal Integrated Clerkship’.

A unique insight into primary care…

Four weeks into the new programme and things are well under way…3 days a week in General Practice, meeting patients through parallel consultations is an ideal way to develop clinical, consultation and practical skills. Being located in the practice setting for almost a year provides a unique insight into primary care delivery and our patient population: From visiting patients in their home environment, seeing a pregnant woman from booking to delivery, following the developing neonate & supporting a palliative patient from diagnosis to death. These are some of the many experiences we are already immersed in, that could only really be achieved through a longitudinal placement.

…Seeing the whole picture

From week two I was encountering some patients for the 2nd or 3rd time for review, or in secondary care for admission/referral/further investigations, right to the point of discharge and follow up…seeing the whole picture. There is great satisfaction that comes with being involved in the patient pathway as a whole and building on patient relationships over weeks or months – where they really appreciate seeing a familiar face throughout their journey.

Integrate with the community

Outside of medicine, the L.C provides a great opportunity to integrate with the community through volunteering with schools, youth organisations & third sector groups. Being in the one location for almost a year creates time to explore the abundant social, sporting and leisure freedoms that rural Scotland has to offer.